Intramedullary nailingdabara ce da aka saba amfani da ita ta gyaran ciki na orthopedic wacce ta samo asali tun shekarun 1940.An yi amfani da shi sosai wajen magance raunin kashi mai tsawo, rashin ƙungiyoyi, da sauran raunuka masu alaka.Dabarar ta ƙunshi saka ƙusa na intramedullary a tsakiyar canal na kashi don daidaita wurin da ya karye.A cikin sauƙi mai sauƙi, ƙusa intramedullary tsari ne mai tsawo tare da yawakulle dunƙuleramuka a ƙarshen duka, waɗanda ake amfani da su don gyara kusa da ƙarshen karaya.Dangane da tsarin su, ƙusoshin intramedullary za a iya rarraba su a matsayin mai ƙarfi, tubular, ko ɓangaren buɗewa, kuma ana amfani da su don kula da nau'ikan marasa lafiya daban-daban.Misali, ƙusoshi masu ƙarfi na intramedullary suna da mafi kyawun juriya ga kamuwa da cuta saboda rashin mataccen sarari na ciki.
Wadanne nau'ikan karaya ne suka dace da kusoshi na intramedullary?
Intramedullary ƙusashi ne manufa dasa shuki don magance karayar diaphyseal, musamman a cikin femur da tibia.Ta hanyar dabarun cin zarafi kaɗan, ƙusa na intramedullary na iya samar da kwanciyar hankali mai kyau yayin da rage lalacewar nama mai laushi a cikin yanki mai rauni.
Rufaffen ragewa da tiyatar ƙusa intramedullary yana da fa'idodi masu zuwa:
Ragewar rufewa da ƙusa intramedullary (CRIN) yana da fa'idodi na guje wa ɓangarorin rukunin da rage haɗarin kamuwa da cuta.Tare da ƙananan ƙwayar cuta, yana guje wa ɓarna mai laushi mai yawa da kuma lalacewa ga samar da jini a wurin da aka karye, don haka inganta yawan waraka na raguwa.Don takamaiman nau'ikanraunin kashi na kusa, CRIN na iya samar da isasshen kwanciyar hankali na farko, yana barin marasa lafiya su fara motsi na haɗin gwiwa da wuri;Hakanan yana da fa'ida sosai dangane da ɗaukar damuwa na axial idan aka kwatanta da sauran hanyoyin daidaitawar eccentric dangane da biomechanics.Zai fi kyau hana sassauta ƙayyadaddun ciki bayan tiyata ta hanyar haɓaka wurin hulɗar tsakanin dasawa da kashi, yana sa ya fi dacewa da marasa lafiya da osteoporosis.
Aiwatar da tibia:
Kamar yadda aka nuna a cikin adadi, aikin tiyata ya haɗa da yin ƙaramin yanki na 3-5 cm kawai a sama da tubercle na tibial, da kuma shigar da screws 2-3 na kullewa ta hanyar incisions na ƙasa da 1 cm a kusa da ƙarshen ƙafar ƙafa.Idan aka kwatanta da raguwar buɗewa na gargajiya da gyare-gyaren ciki tare da farantin karfe, ana iya kiran wannan dabarar cin zarafi ta gaske.
Aiwatar da femur:
1.Interlocking aiki na femoral kulle intramedullary ƙusa:
Yana nufin ikonsa na tsayayya da juyawa ta hanyar kullewar ƙusa intramedullary.
2.Classification na kulle intramedullary ƙusa:
Dangane da aiki: daidaitaccen kulle intramedullary ƙusa da sake ginawa kulle intramedullary ƙusa;akasari an ƙaddara ta hanyar watsa danniya daga haɗin gwiwar hip zuwa haɗin gwiwa, da kuma ko manyan sassa da ƙananan sassa tsakanin masu juyawa (a cikin 5cm) sun tabbata.Idan rashin kwanciyar hankali, ana buƙatar sake ginawa na watsa damuwa na hip.
Dangane da tsayi: gajere, kusanci, da nau'ikan tsayi, galibi waɗanda aka zaɓa bisa tsayin wurin karyewar lokacin zaɓin tsayin ƙusa na intramedullary.
2.1 Daidaitaccen ƙusa na intramedullary
Babban aiki: axial stress stabilization.
Alamomi: Karyewar shaft na mata (ba a zartar da karayar subtrochanteric)
2.2 Sake ginawa interlocking intramedullary ƙusa
Babban aiki: Watsawar damuwa daga kwatangwalo zuwa shingen femoral ba shi da kwanciyar hankali, kuma kwanciyar hankali na watsawa a cikin wannan sashi yana buƙatar sake ginawa.
Alamomi: 1. Karyawar Subtrochanteric;2. Karyewar wuyan mata ta haɗe tare da ɓangarorin ɓangarorin femoral a gefe guda (karya ta gefe ɗaya a gefe ɗaya).
PFNA kuma nau'in ƙusa ne na intramedullary nau'in sake ginawa!
2.3 Tsarin kulle nesa na ƙusa intramedullary
Tsarin kulle nesa na ƙusoshin intramedullary ya bambanta dangane da mai ƙira.Gabaɗaya, ana amfani da dunƙule madaidaiciya guda ɗaya don ƙusoshi na intramedullary na mata na kusa, amma don karyewar igiyar mace ko tsayin kusoshi na intramedullary, a tsaye biyu ko uku na kulle ƙusoshin tare da kulle mai ƙarfi ana amfani da su don haɓaka kwanciyar hankali.Dukan ƙusoshi na femoral da tibial tsayin kusoshi na intramedullary an gyara su tare da makullin kulle guda biyu.
Lokacin aikawa: Maris 29-2023
